Archived: Havilah Office

Updated 2 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 20 and 25 October 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and staff are often out during the day; we needed to be sure that someone would be in.

Before the inspection we reviewed the information we held about the service. No statutory notifications about events that affected the service had been received.

The inspection was carried out by two inspectors. During the inspection we spoke with the registered manager and the operations manager. We looked at two people’s care records, and three staff files, as well as records relating to the management of the service.

After the inspection we made telephone calls to one relative and one member of care staff.

Updated 2 February 2018

The inspection took place on 20 and 25 October 2017 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service for adults and we needed to be sure that someone would be in. Havilah Office provides personal care to people living in their own home. The service provides care and support for people with disabilities and learning disabilities. At the time of our inspection there were two people receiving care.

There was a registered manager at the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection took place in May 2017 when we rated the service as requires improvement, identified breaches of three regulations and served a warning notice in relation to safe care and treatment. This inspection was planned to follow up on whether the service had taken appropriate action to address our previous concerns. At this inspection we found that the service had not taken adequate action to become compliant with these regulations.

People were not protected from risks to their health and wellbeing because risks had not always been identified and existing assessments were not detailed enough to guide staff about how to manage specific risks. Staff did not know how to mitigate certain risks people faced. A relative told us that they had been required to explain to staff how to keep their family members safe while care was provided.

Care documentation was disorganised and was not reviewed on a regular basis. The information contained did not provide enough detail to enable newly allocated staff to provide person-centred care. People were at risk of not being supported to eat and drink enough because there was inadequate guidance about Percutaneous endoscopic gastrostomy feeding (PEG feeding) and there was no formal system to monitor people’s weight where required.

Medicines were not managed safely. Accurate records about which medicines were given were not maintained. The management team did not know all the medicines that were being provided to people and protocols were not in place when medicines were provided on an as required basis.

Staff were not adequately trained to meet people’s needs. Staff were not fully supported in their role by an adequate induction period, supervisions or appraisals. The provider could not be assured that people were suitable for working in the caring profession because they had not recorded the outcome from criminal record checks.

People were usually supported by their family to access healthcare professionals when they became unwell. However, people were at risk of not maintaining their optimum health because staff did not know what to do in all emergency situations and did not know how to monitor people for signs of infection or deteriorating health.

The service was not organised in a way that promoted safe and quality care through effective monitoring systems. The service was not well led and there was not a clear management structure in place.

There were sufficient numbers of staff deployed to meet people’s needs. People were treated with dignity and respect and a relative told us that the care staff worked well with their family members after a period of settling in. Some attempt was made at offering people choices about care tasks however this was not reflected in the care records. A relative told us they knew how to raise concerns if necessary though no formal complaints had been made since the last inspection.

The provider followed the latest guidance and legal developments about obtaining people’s consent to care. People’s relatives had signed care plans to indicate their involvement in care planning as appropriate.

We found five breaches of the regulations around training, safe care and treatment, person-centred care, good governance and meeting nutritional and hydration needs. Full information about CQC’s regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.